Please complete the application form and recruitment monitoring form and return by post or email to the address shown on the job advert. 
If you have any queries please contact us – contact details are provided on the job advert.

Job application form – Confidential

Guidance on completing this form can be found on the last page.
Please complete this section from information on the job advert.
Job title      
Job reference      
Service group      
Closing date      	1.	Guaranteed interview for people with 	disabilities	
	Do you consider yourself to be a disabled person?	Yes	No	
	If yes, do you require any support or adjustments to enable you to take part in the selection process for this job?	Yes	No		
	If yes, give details      	
People with disabilities who meet the essential criteria will be guaranteed an interview – see the Information Booklet for Job Applicants for details.	
2. Personal details
Title	Mr	Mrs	Ms	Miss	Other      	
Surname
Initial
Address	     
    
     	Complete if applicable:
Home telephone number      
Work telephone number      
Mobile number      
Email      	
Postcode	     		
3. Education/qualifications – most recent first
School/college/ 
university/placement	Dates (month/year)	Courses taken/ 
qualifications	Grade	Date (month
/year)	
	From	To				
     	     	     	     	     	     	
Please continue on a separate sheet if necessary.	
Are you currently a member of any professional bodies?	Yes	No
If yes, please state name of body:      
Level of membership attained:      	Membership number:      
Are you registered for CPD (Continuous Professional Development)? 	Yes	No	

4. Present employment
Name and address of present employer
     	Job title      	
	Gross salary/wage       	
	Date of appointment      	
	Notice required      	
Brief details of duties and responsibilities
     	
5. Past employment (paid or unpaid) – most recent first Include all previous employers 
Employer’s name 
(and address if appropriate)	Position held	Dates (month/year)	
		From	To	
     	     	  /    	  /    	
     	     	  /    	  /    	
     	     	  /    	  /    	
     	     	  /    	  /    	
     	     	  /    	  /    	
     	     	  /    	  /    	
Please continue on a separate sheet if necessary.	
6. Relevant training courses attended – most recent first
Organising body	Course details	Dates (month/year)	
		From	To	
     	     	  /    	  /    	
     	     	  /    	  /    	
     	     	  /    	  /    	
     	     	  /    	  /    	
Please continue on a separate sheet if necessary.	

7. Experience
Please give reasons for making this application. See notes on the last page for guidance. Please continue on a separate sheet if necessary.
     	

8. Job share
Are you applying as a job sharer? (See the Information Booklet for Job Applicants for further information)
Yes	No	
9. Relationships
Are you related to any elected member or employee of the council?
Yes	No	If yes, please state who      	
Please note: Canvassing of members or officers of Wolverhampton City Council directly or indirectly in connection with this post will disqualify your application.
10. References – to be completed by ALL applicants including those applying internally 
Note: Referees should not be friends or relatives.
(i) Present/most recent employer	(ii) Previous employer
If no employment history, use teacher or similar.	
Name      
Job title      
Address      	Name      
Job title      
Address      	
Postcode      
Telephone number      
Status/relationship to you      	Postcode      
Telephone number      
Status/relationship to you      	
Please tick this box if you would prefer us not to contact this referee prior to interview: 	Please tick this box if you would prefer us not to contact this referee prior to interview: 	
11. Posts which involve driving
Have you a full current driving licence? Yes	No
Answer only if relevant to mobility requirements of the post/job, or if car allowance applicable.
If LGV/PCV, state category      	
12. Declaration
Note: Complete this section only if completing the form by hand. If completing the form electronically you will be asked to sign the form if selected for interview. 
I certify that to the best of my knowledge the information I have given is correct (providing false information or deliberately omitting relevant information will make the candidate liable to dismissal or disciplinary action if appointed). 
Signature		Date 		

Internal applicants only
13. If you are applying for secondment, you must ensure that this section has been signed by, or on behalf of, your director. If completing the form electronically you should either: 
a) send a print-out of this page with your director’s signature to the human resources team specified on the job advert, or b) ensure that your director emails the human resources team specified on the job advert with the wording below.
I acknowledge your application for secondment and undertake to release you on the terms agreed if successful.
Signature (director/line manager)		Date 		

	Please complete this section from information on the job advert.	
	Job title      
	
	Job reference      
	
	Service group      
	
	Closing date      	
Recruitment monitoring form
This section forms an integral part of the application form and must be completed in full and accurately.
This form is confidential and will not be seen by the selection panel. The information provided on this tear-off slip will be used by the council only to monitor the effectiveness of its equal opportunities and recruitment policies, and will be used only as part of aggregated statistics.
Please complete the following boxes as appropriate (use black pen if completing the form by hand).	
Sex	Disability Do you consider yourself to be a disabled person?	
Female 	Male 			
	Yes 	No 		
Ethnic group
To which ethnic group would you say you belong?
Mark one box only please.
White
British		01
Irish		02
Any other White background		09
Mixed
White and Black Caribbean		10
White and Black African		11
White and Asian		12
Any other Mixed background		19
Asian or Asian British
Indian		20
Pakistani		21
Bangladeshi		22
Any other Asian background		29
Black or Black British
Caribbean		30
African		31
Any other Black background		39
Chinese or Other ethnic group
Chinese		40
Any other ethnic group		49	Age	
	Please indicate the band in which your age falls.	
	Under 25		
	25–34		
	35–49		
	50–65		
	Over 65		
	Postcode	
	 	 	 	 	 	 	 	 		
	Vacancy (mark only one)	
	I became aware of this vacancy through: 	
	AdNews		
	Birmingham Evening Mail		
	Community Care		
	Express & Star		
	Job centre		
	Jobspot vacancy bulletin		
	Jobspot noticeboard		
	Other specialist publication*		
	Recruitment fair		
	The Guardian		
	Times Educational Supplement		
	Website (council)		
	Website (other)*		
	* Please specify publication / website:
     	
For office use only
Shortlisted 	Appointed	Present employment situation	
	Are you currently employed by Wolverhampton City Council?	
	Yes 	No 		

Completing your application form
•	Complete the application form (use black ink if completing the form by hand). Alternative formats, such as CVs or taped applications, are acceptable if you have a disability which prevents you from completing the standard application form.
•	The recruitment monitoring must be completed in full.
•	Add your initial and surname to any additional sheets.
•	Return your completed application form and recruitment monitoring form by email or post to the address shown on the job advert by the stated closing date.
Tips for completing section 7 – Experience
•	The decision to select you for interview will be based on how closely you meet the essential criteria shown on the personnel specification. Use this as a guide to what skills and experience you need to have. These may have been gained from: paid work, voluntary or leisure activities, work in the home, training and education. If you feel you meet any of the desirable criteria, highlight these too.
•	You might find it helpful to do a rough draft first.
•	Try to organise your answer into clear, concise points to demonstrate that you have the skills we are looking for.
•	Accurate spelling, punctuation and grammar help to make a good impression.
•	Highlight your transferable skills. The tasks that you have performed in the past may not be exactly the same as those in the job for which you are applying, but the skills you use to carry out the tasks are likely to be the same.
Recruitment monitoring form
The information you provide on the recruitment monitoring form is confidential and will not be seen by the selection panel or play any part in the selection decision. It will be used as part of aggregated statistics for monitoring purposes only, in order to measure the effectiveness of the council's equal opportunities and recruitment policies.
We look forward to receiving your application.	
Rehabilitation of Offenders Act 1974
Certain posts, particularly those that involve working with children or other vulnerable groups, will be subject to a criminal record check from the Criminal Records Bureau before the appointment is confirmed. This will include details of cautions, reprimands, final warnings and convictions, including 'spent convictions' under the terms of the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Order 2001.
If the post for which you are applying requires such a disclosure this will be indicated on the supporting information that you have received with this form. Any disclosure will be required only if you are selected as the most suitable applicant for the post. The Council also reserves the right to contact previous employers of the successful candidate prior to appointment to confirm employment history.
Data Protection Act 1998
Wolverhampton City Council will use the information provided on this form to process your job application.  Information will remain confidential and is protected by the provisions of the Data Protection Act 1998. The Act gives you the right to see a copy of the information held about you on application to the council's Data Protection Adviser.
Wolverhampton City Council may contact you in the near future for the purpose of completing a questionnaire with a view to improving the recruitment process. Please mark the following box if you do not agree to your data being used for this purpose: 
The council's Data Protection Adviser can be contacted on (01902) 554498 or via e-mail at data.protection@wolverhampton.gov.uk. Further information relating to the Data Protection Act 1998 can be found on the Information Commissioner's Office website at www.ico.gov.uk.